門診恐慌症短期認知行為團體治療之成效與流失因素的探討：一種回溯性研究

The Effectiveness and Attrition of Brief Group Cognitive Behavior Therapy for Outpatients with Panic Disorder: A Retrospective Study

目的：本研究目的係以回溯性方法是檢查在精神科門診對恐慌症病人所實施常規的短期 認知行為團體治療之成效與流失因素。方法：從2005 至2010 年間，有53 位病人參加每週1.5 小時的八週團體。與療效、流失相關的資料是回溯自病人的病歷、團體記錄與心理評量。結 果：於團體結束後，發現團體能有效改善災難性認知與焦慮情緒；並於六個月後追蹤，病人 的恐慌症狀嚴重性、懼曠迴避、對生理激發的害怕感、與憂鬱情緒亦有顯著下降。但流失率 偏高 (45.3%)。最能預測流失的因素是團體前有否恐慌發作，發現有恐慌發作者較能完成團 體。中斷治療的常見理由是實際困難與表示不需要團體治療。結論：此短期認知行為團體治 療為有效與可行的方案。但為預防與減低流失率，可考量病人的篩選標準、提供團體前的諮 詢與不同治療形式等策略。

Objectives: In this study, the authors did a retrospective study to examine effectiveness and attrition of brief group cognitive behavior therapy (CBT) for panic disorder (PD) routinely practiced in the psychiatric outpatient clinic at a general hospital. Methods: A total of 53 patients (37 females and 16 males, with mean age of 44.72 years) had accepted the 8-weekly 1.5 hour group CBT separately during 2005-2010. The data of effectiveness and dropout variables were reviewed from documents of patients’ medical and group records as well as their psychological measures. Results: The brief group CBT was found to have significant improvements in patients’ disaster belief and anxiety level at the end of treatment (p < 0.01), and to decrease their severity of panic attacks (p < 0.01), agoraphobic avoidance (p < 0.01), fear of body sensation (p < 0.05), and depression symptoms (p < 0.05) at 6-month follow-up. But high attrition rate of 45.3% was found. The signifi cant negative predictor of attrition was recent panic attacks recorded before the fi rst group sessions (p < 0.05). Recent panic attacks motivated them to complete group sessions. Reasons of their discontinuing treatment included practice problems and treatment being not needed. Conclusion: These study results suggest the brief group CBT for PD is an effective and feasible treatment in the psychiatric outpatient clinic. Strategies to prevent and to reduce attrition, such as setting up recruitment criteria, doing orientation interview, or adapting alternative modes of delivering CBT should be considered in the future.